Asim Ozayar

Minimally Invasive Percutaneous Treatment of Small Renal Tumors with Irreversible Electroporation: A Single-Center Experience

PURPOSE To evaluate whether irreversible electroporation (IRE) can be used as an ablation technique for small renal tumors (T1a cancers or small benign tumors) and to describe features after ablation on computed tomography (CT) or magnetic resonance (MR) imaging. MATERIALS AND METHODS In this retrospective study, 20 patients (mean age, 65 y ± 12.8 y) underwent CT-guided IRE of T1a renal carcinoma (n = 13) or small benign or indeterminate renal masses < 4 cm in size (n = 7). Mean tumor size was 2.2 cm ± 0.7. The ablation area was verified with contrast-enhanced imaging performed immediately after the procedure to determine technical success. Imaging was performed 6 weeks (20 of 20 patients), 6 months (15 of 20), and 12 months (6 of 20) after ablation. Medical records and CT/MR imaging features of all patients were reviewed for recurrence, symptoms, and complications after treatment. RESULTS Technical success was achieved in all patients (100%); there were no major procedure-related complications. Minor complications occurred in 7 patients, including self-limiting perinephric hematomas, pain difficult to control, and urinary retention. Mean procedure time was 2.0 hours ± 0.7. At 6 weeks, 2 patients required salvage therapy because of incomplete ablation. At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 6) was noted to have experienced recurrence. CT/MR imaging after IRE ablation demonstrated an area of nonenhancement in the treatment zone that involuted over ~6 months. CONCLUSIONS Renal IRE appears to be a safe treatment for small renal tumors. Tumors treated with IRE demonstrated nonenhancement in the treatment zone with involution on follow-up CT/MR imaging.

Evaluation of a New Ultrasound Measurement Tool for the Diagnosis of Dysfunctional Voiding in Pediatric Population: Full/Empty Bladder Wall Thickness Ratio

OBJECTIVE To investigate the roles of bladder wall thickness (BWT) measurement and full/empty (F/E) BWT measurement ratio in the diagnosis of dysfunctional voiding in pediatric population. METHODS Totally, 324 patients were involved in this prospective study, and group 1 consisted of healthy children (n=198), and group 2 consisted of patients with dysfunctional voiding (n=126). BWT measurements were done at the anterior, posterior, and lateral walls, and F/E BWT ratios were calculated. Two groups were compared for BWT measurement, and receiver operating characteristic analysis was performed to find out a cutoff value for BWT and F/E BWT ratios. RESULTS Mean age of group 1 was 6.4 years and that of group 2 was 6.5 years. BWT measurements were higher in the empty state compared with full state and in boys compared with girls. However, BWT ratios did not show significant difference between male and female patients. F/E BWT ratios were found to be higher in group 2 compared with group 1 (P=.02). In receiver operating characteristic analysis, a cutoff value of 0.324 (sensitivity 66.67% and specificity 79.80%) and 0.295 (sensitivity 83.33% and specificity 64.14%) was found for anterior and posterior F/E BWT rates, respectively. CONCLUSION Ultrasonographic measurement of BWT and calculation of F/E BWT ratio may serve as a noninvasive tool for evaluating lower urinary tract symptoms in children. Further studies including larger number of patients would be of great interest.

Equivocal Ureteropelvic Junction Obstruction on Diuretic Renogram—Should Minimally Invasive Pyeloplasty be Offered to Symptomatic Patients?

PURPOSE Equivocal ureteropelvic junction obstruction refers to clinical symptoms and/or other radiological suggestions of possible ureteropelvic junction obstruction but with inconclusive results of obstruction on diuretic renogram. We evaluated long-term outcomes in patients with equivocal ureteropelvic junction obstruction treated with minimally invasive pyeloplasty. MATERIALS AND METHODS We retrospectively analyzed the records of 125 consecutive patients who underwent minimally invasive pyeloplasty as performed by a single surgeon from May 2004 to July 2013. Of 98 patients with followup those with more than 6-month followup were included in analysis. Equivocal ureteropelvic junction obstruction, defined as half-life less than 20 minutes on diuretic renogram, was identified in 23 patients. All patients underwent transperitoneal minimally invasive pyeloplasty. We evaluated patient demographics, preoperative and postoperative symptoms and renal function. RESULTS The 16 female and 7 male patients with equivocal ureteropelvic junction obstruction had flank pain and associated hydronephrosis on imaging. At a median followup of 20.2 months (range 7 to 75) 95.7% of patients with equivocal obstruction achieved complete symptom resolution. Mean ± SD preoperative and postoperative half-life was 14.1 ± 3.7 and 7.4 ± 4.2 minutes, respectively, for an improvement of 6.7 minutes (p < 0.001). In 1 patient (4.3%) with equivocal obstruction of a complicated iatrogenic etiology treatment ultimately failed postoperatively and endopyelotomy was required. There was no statistically significant difference in clinical or radiological success between the equivocal obstruction group and the 75 patients treated with minimally invasive pyeloplasty for definitive ureteropelvic junction obstruction (p = 0.44 and 0.07, respectively). CONCLUSIONS In patients with radiographic equivocal ureteropelvic junction obstruction and flank pain minimally invasive pyeloplasty efficaciously provides symptomatic relief and functional preservation. Results are comparable to those in patients with high grade obstruction.

Comparative Effects of Irreversible Electroporation, Radiofrequency Ablation, and Partial Nephrectomy on Renal Function Preservation in a Porcine Solitary Kidney Model

OBJECTIVE To evaluate kidney function preservation or regeneration and pathological changes post-irreversible electroporation (IRE) in comparison with partial nephrectomy and radiofrequency ablation (RFA) in a solitary kidney porcine model. Tissue ablation using IRE has been reported to spare critical anatomic structures within or near the ablation zone with associated regeneration of adjacent parenchyma, possibly offering functional preservation. METHODS Fifteen pigs initially underwent laparoscopic nephrectomy. The lower third of the remaining kidney was then ablated or removed with either IRE, RFA, or partial nephrectomy. Serum creatinine (SCr) was measured at baseline, 24 hours, 3, 7, 14, and 28 days postoperatively. The impact of the type of procedure on SCr over time was evaluated. Acute and chronic histological changes were analyzed and cellular viability was assessed using nicotinamide adenine dinucleotide staining in the IRE ablations. RESULTS Ten ablations (5 IRE, 5 RFA) and 5 partial nephrectomies of the entire lower third of a solitary kidney were performed. The type of procedure did not affect SCr significantly at baseline (P = .14) or change in SCr over time (P = .48). Histologically, IRE and RFA lesions showed similar findings including coagulative necrosis that progressively was replaced by reparative stromal changes and fibrous tissue. Nicotinamide adenine dinucleotide staining of the IRE lesions at 14 and 28 days showed no viability in the necrotic areas with viable tissue at the margins demonstrating reparative changes. CONCLUSION Large volume IRE ablation of normal renal parenchyma in the porcine model does not provide a functional advantage as compared with conventional renal tumor treatments.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy: From the View of an Anesthesiologist

PURPOSE To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. PATIENTS AND METHODS Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO2) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. RESULTS SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013). CONCLUSION Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

Evaluation of Oxidative Stress Status and Antioxidant Capacity in Patients with Localized Prostate Cancer and Benign Prostatic Hyperplasia

1 Mustafa Aldemir1, Yücel Altay1, Emrah Okulu1, Kemal Ener1, Asım Özayar1, Cem Nedim Yücetürk2, Özcan Erel3 1Atatürk Teaching and Research Hospital, Department of Urology, 2Ankara Teaching and Research Hospital, Department of Urology, 3Atatürk Teaching and Research Hospital, Department of Biochemistry, Ankara, Turkey Localize Prostate Kanseri ve Oksidatif Stres / Localized Prostate Cancer and Oxidative Stress Evaluation of Oxidative Stress Status and Antioxidant Capacity in Patients with Localized Prostate Cancer and Benign Prostatic Hyperplasia Lokalize Prostat Kanseri ve Benign Prostat Hiperplazi Hastalarında Oksidatif Stres Durumu ve Antioksidan Kapasitenin Değerlendirilmesi

Prompt Management of Anastomotic Leak or Acute Obstruction after Minimally Invasive Pyeloplasty with Percutaneous Nephrostomy Preserves Outcomes

PURPOSE Urine leak or obstruction in the early postoperative period is a worrisome complication of pyeloplasty. Suboptimal management may risk long-term success. We evaluated percutaneous nephrostomy to manage complications of minimally invasive pyeloplasty. MATERIALS AND METHODS We retrospectively analyzed the records of 125 patients who underwent minimally invasive pyeloplasty performed by a single surgeon from May 2004 to May 2013. All complications were catalogued and patients with anastomotic urine leakage or postoperative obstruction were identified. Less than 7 days postoperatively percutaneous nephrostomy was done in each case. Surgical success was defined as resolution of flank pain and/or improved half-time (less than 20 minutes) on diuretic renogram. RESULTS Early percutaneous nephrostomy placement was required in 12 patients (9.6%) for symptomatic obstruction (6) or anastomotic urine leakage (6) a median of 4.5 days (range 2 to 7) postoperatively. Percutaneous nephrostomies remained in place a median of 9.5 days (range 5 to 42). Median followup was 15 months (range 2 to 80). Mean half-time was 36.4 minutes preoperatively and 11.1 minutes postoperatively. Continued postoperative obstruction (half-time greater than 20 minutes) was documented in 1 (8%) and 13 patients (11.5%) who did and did not require percutaneous nephrostomy placement, respectively. There was no statistical difference in radiological and clinical success rates between the percutaneous nephrostomy group and the 113 patients in whom minimally invasive pyeloplasty was uncomplicated (p = 0.74 and 0.28, respectively). CONCLUSIONS In patients treated with minimally invasive pyeloplasty aggressive management of acute urinary complications with percutaneous nephrostomy placement preserved radiographic and symptomatic outcomes that were comparable to those in patients without complications.

MP100-11 PERCUTANEOUS IRREVERSIBLE ELECTROPORATION OF RENAL TUMORS: OUTCOMES AFTER MEDIAN 2 YEAR FOLLOW-UP

investigate the cost of pre-procedure biopsy of renal masses vs immediate cryoablation with intraoperative biopsy for patients with small renal masses who are candidates for cryotherapy. METHODS: We retrospectively identified all patients who had laparoscopic cryoablation for a renal tumor by a single surgeon at an academic center between 2004 and 2013. Pathology results from intraoperative biopsies were collected. Cost analysis was performed for two treatment algorithms. Algorithms differed in the initial step in management: CT guided biopsy vs laparoscopic cryoablation with intraoperative biopsy. RESULTS: There were 96 patients in the study. Pathology results from intraoperative biopsies were: Cancer: 64 (66.7%), Indeterminate: 12 (12.5%), and Benign: 20 (20.8%). Cost of laparoscopic cryoablation and hospital stay is

Evaluation of oxidative stress status and antioxidant capacity in patients with renal cell carcinoma.

10,600. Cost of a CT guided biopsy is

A Two Years Follow-Up Study of Children with Monosymptomatic Enuresis Treated with Enuresis Alarm

5,400. Cost of 5 years of surveillance is